When we remove a tumor, our goal is to reconstruct the defect to restore both function and aesthetics, thereby improving the patient’s quality of life. For small defects resulting from tumor removal, we can often use tissue from the surrounding area (known as a local flap) for reconstruction.
For example, in a case involving a young lady with skin cancer on the tip of her nose, we successfully removed the cancer and reconstructed the area by mobilizing surrounding tissues. Her recovery was remarkable, and she returned 10 days post-surgery for suture removal.
In another instance, a gentleman underwent a wide local excision for cancer of the lower lip. We reconstructed the defect by moving a small part of the upper lip to the lower lip, which is an effective method to maintain oral sphincter function and achieve a pleasing aesthetic result.
Sometimes, repairs require tissue from a distant and unrelated part of the body, known as a graft (such as skin, fat, nerve, bone, etc.), which does not have its own blood supply and relies on the blood supply of the defect area for survival. For instance, we used a split skin graft from the thigh to line the area around two bone-anchored implants on the left side of the lower jaw.
However, for larger surgical defects or when the blood supply to the surrounding areas is compromised due to factors like previous infections, radiotherapy, or scarring, we use tissue from a distant part of the body. This tissue, harvested with its own arteries, veins, and nerves, is known as a free flap. In microvascular surgery, these are connected under a microscope to corresponding structures in the defect area. The advantage of a free flap is that it does not rely on the local tissue’s blood supply for survival.
Another patient had cancer in the lower jaw, requiring resection of the jawbone from angle to angle. We reconstructed it using bone harvested from the leg, complete with its artery and vein. This procedure involved 3D planning and the placement of six oral rehabilitation titanium implants to restore teeth and mouth function. Five years later, the patient is cured and can eat, drink, and speak normally, with the scars being virtually invisible.”
Our range of reconstructive surgeries includes everything from simple local flaps to complex free flap surgeries with microvascular anastomosis. For example, a patient with tongue cancer underwent removal of the tumor and reconstruction using a free flap from the left forearm skin. The arteries and veins from the forearm flap were meticulously joined to vessels in the neck under a microscope, ultimately restoring normal eating and speech functions.
Private:
Auckland Head & Neck Specialists, MercyAscot,
100 Mountain Road Epsom.
E-mail: info@ahns.co.nz
Greville Dental (Visiting Surgeon), 18 Hauraki Crescent, Pinehill. E-mail: info@ofhnsurgery.co.nz
